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NEW PATIENT FORM Name: Last First Middle DOB: / / Age: SSN: Sex: Status: Married Male Female Single Preferred Name Divorced Widowed Address: Street Phone: (H) City (W) Referring Dentist: State Zip
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How to fill out referring dentist

How to Fill Out Referring Dentist:
01
Begin by locating the field labeled "Referring Dentist" on the form or document you are filling out. This field is typically found in the section that requires information about the dental treatment or consultation.
02
Once you have located the "Referring Dentist" field, carefully write or type the name of the dentist who referred you or the patient to the current dentist. Ensure that you provide the complete and accurate name of the referring dentist.
03
Double-check the spelling of the referring dentist's name before submitting the form or document. Accuracy is essential to avoid any confusion or potential errors in communication.
Who Needs Referring Dentist:
01
Patients seeking specialized dental care: Individuals who require specialized dental treatments or procedures may need to be referred by their primary dentist to a specialist. This referral allows the specialist to have access to the patient's dental history and specific information from the referring dentist.
02
Dentists seeking consultation: Dentists might need the guidance or input of a more experienced or knowledgeable colleague in certain cases. They refer the patient to another dentist who can provide a second opinion or recommend a particular treatment plan.
03
Dental insurance purposes: Some dental insurance plans require a referral from the primary dentist before they cover certain treatments or consultations with specialists. The referring dentist's information is essential for insurance providers to verify the necessity and eligibility of the referred dental care.
In conclusion, filling out the referring dentist section involves providing accurate details about the dentist who has referred you or the patient to the current dental practitioner. It is necessary for effective communication, coordination of care, and insurance purposes.
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